CAJ | 학술논문

目的比较新生儿听力筛查两阶段和三阶段的成本效果,为普遍性筛查提供依据.方法对2010年10月至2012年12月北京市7家医院出生的正常新生儿进行听力筛查,分别采用两阶段和三阶段策略及听力诊断性检查,比较两种筛查的成本/效果比.其中筛查和诊断成本数据源自医院,采用自行设计问卷对家长调查额外交通费和误工费.根据依从率进行敏感性分析.结果新生儿初筛62 695人,未通过5 809人,阳性率为9.30％;复筛4 933人,未通过972人,阳性率为19.70％;复筛未通过并就诊于指定医疗机构者412人.完成诊断性评估360人,听力异常者217例,听力异常率为60.28％.完成三阶段筛查共276人,未通过163人.其中125人完成诊断性检查,异常112例(中度以上45例),听力异常率为89.60％.以实际筛查率和诊断率计算成本/效果比,两阶段(19 985元/例)优于三阶段(37 242元/例),但随着筛查依从率的提高,三阶段筛查的成本效果也随之提高.结论筛查依从率影响三阶段筛查的成本效果,在筛查依从率较高(＞90％)的地区可考虑使用三阶段筛查方法.
목적 비교신생인은력사사량계단화삼계단적성본효과,위보편성사사제공의거.방법 대2010년10월지2012년12월북경시7가의원출생적정상신생인진행은력사사,분별채용량계단화삼계단책략급은력진단성검사,비교량충사사적성본/효과비.기중사사화진단성본수거원자의원,채용자행설계문권대가장조사액외교통비화오공비.근거의종솔진행민감성분석.결과 신생인초사62 695인,미통과5 809인,양성솔위9.30％;복사4 933인,미통과972인,양성솔위19.70％;복사미통과병취진우지정의료궤구자412인.완성진단성평고360인,은력이상자217례,은력이상솔위60.28％.완성삼계단사사공276인,미통과163인.기중125인완성진단성검사,이상112례(중도이상45례),은력이상솔위89.60％.이실제사사솔화진단솔계산성본/효과비,량계단(19 985원/례)우우삼계단(37 242원/례),단수착사사의종솔적제고,삼계단사사적성본효과야수지제고.결론 사사의종솔영향삼계단사사적성본효과,재사사의종솔교고(＞90％)적지구가고필사용삼계단사사방법.
Objective To evaluate the cost-effectiveness of two-stage and three-stage hearing screenings for newborns.Methods Hearing screening was performed for the normal newborns born in 7 hospitals in Beijing from October 2010 to December 2012 by using two stage and three stage strategies as well as hearing diagnostic test,and the cost effectiveness evaluation of two strategies was conducted.The data about the cost of screening and diagnostic test were from the hospitals.The data about car fare and charge for loss of working time of parents were collected through questionnaire survey.The sensitivity was analyzed according to the compliance rate.Results A total of 62 695 newborns received initial hearing screening,5 809 newborns failed,the positive rate was 9.30％.A total of 4 933 newborns received rescreening,972 newborns failed,the positive rate was 19.70％.Among the newborns failed in rescreening,412 were provided with hearing diagnostic test and 360 received diagnostic test.The diagnostic test indicated that the hearing of 217 newborns were abnormal received diagnostic test and 112 had abnormal hearing (45 had moderate and above heating impairment),the abnormal rate was 89.60％.The average cost for three-stage screening (37 242 yuan RMB per case) was higher than that for two-stage screening (19 985 yuan RMB per case).With the increase of compliance,the cost-effectiveness of three-stage screening increased.Conclusion The cost-effectiveness of three-stage screening was influenced by screening compliance.It is recommended that three-stage screening strategy might be taken in area where the screening compliance rate is ＞90％.(60.28％).A total of 276 newborns received the third screening,163 newborns failed,in which 125received diagnostic test and 112 had abnormal hearing(45 had moderate and above heating impairment),the abnormal rate was 89.60％.The average cost for three-stage screening(37 242 yuan RMB per case)was higher than that for two-stage screening(19 985 yuan RMB per case).With the increase of compliance,the cost-effectiveness of three-stage screening increased.Conclusion The cost-effectiveness of three-stage screening was influenced by screening compliance.It is recommended that three-stage screening strategy might be taken in area where the screening compliance rate is ＞90％.